Abstract 988

Mycoplasma hominis is an opportunistic organism found in the genital tract of 20-40% of asymptomatic women and has been reported to colonize 15% of newborn infants. Colonization of the infant, presumably during passage through the birth canal, is usually asymptomatic, but cases of CNS infection due to Mycoplasma hominis have been reported. Scalp abscesses resulting from introduction of vaginal flora into subcutaneous tissues at the fetal monitoring electrode insertion site have also been reported. This report concerns a term male infant delivered vaginally to a 16 year old Caucasian with an unremarkable pregnancy, late prenatal care starting at 24 weeks, and spontaneous rupture of membranes with clear fluid 26 hours prior to delivery. The immediate neonatal course was uneventful. At ten days of life, the infant was admitted with a rectal temperature of 102.7° and a two-day history of irritability and decreased feeding. Physical examination revealed a full, fluctuant fontanel, a 5mm scab on the posterior left parietal scalp without erythema or drainage, and two 1mm scabbed areas adjacent to the central site. Initial CBC showed a WBC count of 14,400/cu mm (41%PMN, 10% bands, 36% lymphs), hemoglobin 13.3g/dl, and platelets of 1,060,000/cu mm. CRP was 9.2. CSF cell count showed 8,800 WBC (94%PMN, 6%monos) and 10,400 RBC/cu mm, glucose 10mg/dl, and protein 453mg/dl. No organisms were revealed by Gram stain or bacterial antigen testing. CSF was eventually negative for herpes simplex by pcr. The infant was empirically treated with ampicillin, gentamicin, and acyclovir. CSF and blood cultures were negative at 48 hours, but the infant's clinical condition worsened. Head ultrasound revealed dilated ventricles, MRI revealed multiple subdural abscesses, and EEG was normal. In the face of cultures negative for routine pathogens, a repeat lumbar puncture was done 48 hours after admission with 300 WBC/cu mm (92%PMN, 8%,monos), 12,500 RBC/cu mm, glucose 7mg/dl, and protein 412mg/dl. Again Gram stain revealed no organisms. This CSF specimen was additionally inoculated for Ureaplasma and Mycoplasma. Clindamycin was added to the antibiotic treatment. Within 36 hours, large colony Mycoplasma were identified. The infant remained free of focal neurological deficits, the anterior fontanel remained full with increasing head circumference, and he developed apnea with possible seizure activity. Head ultrasound revealed increased size of the lateral and third ventricles, and EEG showed a temporal lobe focus correlating with the largest subdural collection. Clindamycin susceptibility was documented in vitro. The infant was treated with clindamycin and gentamicin for 21 days and at time of discharge there was improvement clinically and radiologically. This case underscores the importance of suspecting unusual pathogens (opportunists in the vaginal flora) particularly in the presence of prolonged rupture of membranes and scalp lesions, and having the microbiological capability to identify these pathogens.